Provider Enrollment Specialist
Alton, Illinois, United States of America
Full Time
2 days ago
Key skills
Communication
About this role
The primary purpose of this position is to assist the Credentialing Lead and Sr. Director, MVC/RCM perform the duties required to credential all doctors for all medical and vision plans.
- Support the team in processing documentation required to initiate and maintain proper medical credentialing for doctors, both IOA & external providers, organizing and obtaining all needed documents from insurance plans and doctors, and submits to the insurance board for processing
- Tracks credentialing in process utilizing Credential My Doc and maintains credentialing files on each O.D. and M.D.
- Loads all new Doctors information into Credential My Doc, as well as maintains all Doctors files in Credential My Doc
- Maintains and updates all doctor’s CAQH applications
- Maintains credentialing spreadsheets and communicates changes in status to billing, retail, and call center staff
- Assists in on-boarding new doctors to initiate smooth credentialing process
- Assists the doctors in filing for/renewing OD and drug licenses
- Maintains excellent working relationships with payors and carrier contracting teams to ensure timely and accurate credentialing status
- Assist the Managed Care Director in activities related to contracting medical and vision plans
- Performs clerical / administrative duties in support of the Credentialing Lead and Sr. Director, MVC/RCM
- Makes recommendations for efficiencies, processes, etc. which will deliver either quality, cost savings, and / or profitability improvements within the department
- High School or GED
- Experience in the managed care / medical insurance field
- Prior credentialing service experience, preferably in an medical or optometric environment
- Ability to understand insurance terminology & concepts to interpret plan requirements
- Effective verbal and written communication skills to speak with internal & external customers
- Basic PC skills to include MS Office, Windows, Word, and Excel
- Demonstrated ability to work successfully in a team environment, functioning for the good of the team over the individual
Benefits
- 401(k) with Match
- Medical/Dental/Life/STD/LTD
- Vision Service Plan
- Employee Vision Discount Program
- HSA/FSA
- PTO
- Paid Holidays
*Benefits applicable to full Time Employees only.
Physical Demands
- This position requires the ability to communicate and exchange information, utilize equipment necessary to perform the job, and move about the office.